This chapter highlights some of the current health programs and policies in place and changes in demographic trends for older adults living within American society. In addition, substantial changes within the social, political, and cultural expectations of communities over the past century pose challenges for policies and programs serving older adults. The chapter presents several issues emerge as realities within the context of policy development and program planning for older adults. These issues include changes in living arrangements, education levels, economic well-being, and rural population settings; trends in morbidity and mortality; and changes within the social, political, and cultural expectations of communities. Despite the availability of programs and services resulting from health policies, many programs have focused upon “medically necessary” services and have lacked a health promotion, health education, or community-based focus.
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- Go to chapter: Background and Demographic Profile of People Growing Older and/or People With Disabilities
This chapter briefly discusses the history of the Caregiver Support Act and its specific components and explains how the Caregiver Support Act provides resources to older adults and people with disabilities. It provides an overview of the current status of family members serving as caregivers, with special attention to grandparents raising grandchildren. It then discusses a current profile of relative caregivers raising children in the United States; reasons for the increase in relative caregiving; and issues facing grandparents raising grandchildren. It also provides some background into the literature and promotes an awareness of issues that grandparents face as primary caregivers. A literature review examines some of the current issues and services needed. The chapter discusses resources and services designed to meet the needs of grandparents raising grandchildren, and reviews programmatic responses through the national resources. Finally, the chapter outlines some best practice interventions for review in the text.
This chapter helps the reader to understand the history of the Americans with Disabilities Act (ADA), specific components of the ADA and how the ADA provides resources to older adults and people with disabilities. The ADA, while groundbreaking, was not initially intended for people with disabilities rather than for older adults. As time progressed, however, the benefits of the ADA were much more far-reaching than originally intended, especially for aging adults with disabilities. The individual titles of the ADA have had some dramatically positive and specific impact for older adults wishing to remain in their homes or in their communities as long as possible. Although the ADA is still in its young adulthood, the benefits of the ADA have only grown as new and further linkages, such as the ADRCs, have developed in all regions of the United States.
This chapter presents a brief overview of some legislative efforts within the mental health (MH) arena and examined their limitations and application with respect to older adults and people living with mental illness. The chapter also takes us through a journey to examine the current status of MH and older adults, with a particular emphasis on depression, anxiety, and schizophrenia. It discusses and reviews the programs, services and issues still outstanding within the MH arena. The chapter helps the reader to understand specific components of the Community Mental Health Act and other MH-related legislation. Many of the community day hospital programs and community MH programs administered through the Community Mental Health Act are based on the deinstitutionalization paradigm since the goal is to treat people outside the institution and within community settings. It concludes with laying out some challenges for the future in the area of MH and older adults.
This chapter helps the reader to understand the history of the Elder Justice Act (EJA). It provides specific components of the EJA and how programs and services flow for older adults and people with disabilities. The chapter discusses the limitations in programs and services within the EJA. The EJA requires the oversight and the appropriation of federal funding to protect people growing older and people with disabilities from abuse. It addresses legal issues with a special emphasis on the concept of a power of attorney. The chapter explores several legal issues that face older adults. It also address elder abuse, power of attorney, and a differentiation made between the types of power of attorney and the healthcare power of attorney. In addition, the chapter explores legal services provided to older adults as a result of the Older Americans Act, and outlines the challenges within the realm of legal issues.
This chapter briefly discusses the history of the Affordable Care Act (ACA) and community and presents specific components of the ACA in relationship to community prevention. The chapter deals with specific aspects of the legislation that impact older adults and people with disabilities. It presents a short review of the ten titles: Title one: quality, affordable health care for all Americans; Title two: role of public program; Title three: improving the quality and efficiency of health care; Title four: prevention of chronic disease and improving public health; Title five: health care workforce; Title six: transparency and program integrity; Title seven: improving access to innovative medical therapies; Title eight: Class Act; Title nine: revenue provision; Title ten: strengthening quality, affordable health care for all Americans. The chapter explains some of the legislative highlights, policies, and programs that have been articulated within each of the specific titles of the ACA.
This chapter focuses on sources of evidence for evidence-based policy development. It explores some of the dilemmas with developing an evidence base and provides a range of empirical sources within the aging and disabilities arenas that can be used in building an evidence-based approach to policy development. The journey, however, will not be without struggle—since philosophical paradigms, and social and economic factors will interface and play a role in the development of evidence-based policy. The chapter helps the reader to be aware of healthy people 2020 benchmarks that are used to guide program planning and policy development. Benchmarks currently have been established in order to identify where health goals for the nation and individual states should be, and the program is evaluated routinely by local and state health departments. Healthy people 2020 is also used to gauge the impact of health policy.
This chapter discusses the history of the Medicare in the United States; specific components of Medicare Parts A, B, C, and D; and how Medicare provides healthcare resources to older adults and people with disabilities. Medicare, a healthcare program perceived to be a universal program rather than one based upon a needs test, currently provides healthcare to people who reach the age of 64. Comprised of four parts, it can provide hospital care, general healthcare, hospice care, home healthcare, and prescription drug coverage. The chapter provides an overview of the Medicare program, its various components, and aspects of healthcare that are covered through its component parts. Although there are currently no needs tests or limitations as to who qualifies for services, the chapter concludes with some dilemmas for the future of healthcare coverage, including “an empty pot at the end of the rainbow” and rationing of healthcare services and procedures.
This chapter helps the reader to understand the history of the legislation related to substance use and misuse. It provides specific components of the Controlled Substances Act. The chapter discusses how legislation related to substance use and misuse provides resources to older adults and people with disabilities. Since substance use/misuse is often perceived as “blaming the victim”, models of care and rehabilitation are often not taken into serious consideration. Prevention, screening, detection, and intervention strategies to meet the needs of baby boomers as they age will be another challenge. Evidence suggests that substance use has been on the rise for the population in general among people living in the community. The chapter reviews programs and services and issues. The chapter concludes by laying out some challenges for the future in the area of substance use and abuse among older adults and people with disabilities.
This chapter helps the reader to understand the history of housing and long-term care for older adults and people with disabilities and specific components of the Long-Term Care Reconciliation Act. The chapter discusses how legislation related to housing and long-term care provides resources to older adults and people with disabilities. It explains community-based care options such as home health, seniors congregate living, assisted living options, skilled nursing facilities, and long-term care facilities. Although differences may exist from state to state relative to who qualifies for these options and when they qualify, these will be discussed in some detail specifically providing an overview of these as options for care management of older adults. The chapter describes different residential models of care for people as they require community-based settings or settings with supports and examines issues that will face the long-term and community-based care settings in the future.